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When Speaking Is A Challenge: Childhood Apraxia of Speech and Other Speech Delays

11/21/2016

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If your child fails to meet these milestones, then a pediatrician may recommend a speech evaluation.

Speaking isn’t always easy for young children. Some may stutter. Others might have a lisp. There are also late bloomers. But for some children, it’s a challenge to even form the words. How do you, as a parent, know when it is time for an intervention and what can be done?

Pediatricians mark milestones according to the national average. At eight months old, the majority of children are babbling, and they say their first word near their first birthday. Between the ages of one and 1 ½, a baby’s vocabulary should grow to approximately 50 words. And by the time they are two years old, toddlers should be able to put two words together. If your child fails to meet these milestones, then a pediatrician may recommend a speech evaluation.

From birth until three years old, young children who qualify can receive speech services through a state-funded program called Early Intervention (EI). “EI is one of the best things in the world,” says Lynn Marsh, a speech and language pathologist at Riley Hospital for Children at Indiana University Health. “Kids just blossom from that program. If there aren’t any known developmental disabilities, there are usually enough early warning signs to justify therapy at 18 months, and they are often diagnosed with a motor speech disorder. Around two years old, they may receive a diagnosis of expressive language disorder.”

By the time children turn three years old and age out of EI, many are now hitting their milestones and no longer need therapy. But for those who continue to demonstrate delays, they may receive a diagnosis of Childhood Apraxia of Speech and require continued therapy with a speech pathologist. Children with apraxia of speech have the capacity to produce sounds but have difficulty planning the movements for speech. For these children, messages between the brain and mouth do not easily occur.

While there is no official cause of apraxia, there are several indicators that may lead to an evaluation. If a child has difficulty saying longer words and phrases, cannot say some words or may pronounce some words differently each time, then an evaluation will be recommended. Children with apraxia may also have more difficulty with self-generated utterances compared to over-learned ones, or they may say a word correctly one time but be unable to do so the next.

“As a coping mechanism, these children regularly point to what they need and have often developed their own gestures for key words such as milk, ball or food,” Marsh explains. “Often, children with apraxia understand everything people say but choose not to speak because they know it will come out funny or not how they intended. For bright children who are typically developing in other areas, their speech delay is a clear indicator of apraxia.”

Among typically developing children, apraxia can sometimes lead to behavioral issues. When a child is trying to get a parent or caregiver to understand, but they simply cannot form the proper words, the child becomes frustrated and eventually everyone gets upset. Additionally, as children grow, they often express anger that they go to speech therapy but their friends or siblings do not. Children may also become defiant and need to work with a behavioral therapist as well.

Children with apraxia often make limited or slow progress in traditional speech-language therapy so speech pathologists utilize a variety of specialized therapies, depending on the child. Marsh has seen great success in young children through the Kaufmann Speech Praxis program that teaches children to combine consonants and vowels to form words. Others benefit from visual cues where the therapist touches their own to chin to show how the mouth moves. Another common form of therapy for children with apraxia is PROMPT where the child’s jaw, tongue or lips are touched to guide them through forming the words.

Regardless of the therapy style, the most important piece of the puzzle is the parents. “I like to have the parents in the session with me so they learn what to do,” Marsh explains. “I’m only with the kids a limited amount of time, but the parents are with their children every day. Parents are a vital piece and often the kids that do well have a whole team – the parents as well as me. It’s about a little bit of practice every day instead of a ton of practice once a day. Kids do well when they practice.”

Marsh recommends that parents schedule therapy as it works for the family and their lives. Children usually receive therapy once a week, but some do come twice. When she sees an indication that a child is “about to hit an upswing and rapidly improve,” she will try to get them in twice a week so “they can rocket forward.”

By kindergarten, most children with apraxia of speech are testing within the normal limits for their age. While there may be one difficult sound that lingers, such as a “k” or an “s,” the proper therapy method and practice at home has resulted in children who overcome their motor planning difficulties and can now speak clearly, no longer needing therapy.